A Latent Class Analysis of Forensic Psychiatric Patients in Relation to Risk and Protective Factors

Abstract

Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions.

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

“…In Wallonia psychotic diagnoses were found more frequently and in Flanders this was the case for personality disorders (33). Multiple diagnoses were actually found, and a high number of substance misuse disorders were part of the current study, which is in line with other research (10,33).…”

“…In Italy, a diagnosis of personality disorder was negatively associated with admission to a high security forensic unit ( 3 ). In contrast personality disorders and substance use disorders were frequently found in Dutch high security populations ( 10 ). Treatment length was variable: the median hospital stay in high security institutions in England and Wales was 6.9 years ( 5 ), and in Norway, it was <1 year ( 1 ).…”

The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients

“…It is important to note, however, that a post-hoc ANOVA analysis showed that at the moment of juridical assessment (T1) and after the first 12 months of the stay in the FPCs (T2), psychotic patients scored significantly higher on the clinical scale, and the risk subscale, and significantly lower on the protective skills subscale than non-psychotic patients. This is consistent with evidence that individuals with a psychotic diagnosis are at higher risk for violence and criminal behavior than those without this diagnosis ( 17 , 22 , 31 ). That said, significant differences in trajectories of the clinical scale, and the risk and protective subscales in the first phase of the stay may be attributed to the differences in the initial levels of the risk and protective factors between psychotic and non-psychotic patients.…”

“…In addition, we did not find significant differences between cluster B and non-cluster B PDs patients in the trajectories of the clinical scale, and the protective skills subscale. It could be speculated that differences were only found for the risk factors as they are more pronounced in patients with cluster B PDs ( 17 , 23 , 42 – 44 ) than the lack of protective factors ( 17 , 68 ).…”

“…Furthermore, it is important to underline that the patients in high-security forensic psychiatric institutions differ in terms of dynamic risk and protective factors, which may be partly attributed to their diverse psychiatric diagnoses ( 16 , 17 ). Substance use disorders (SUD) and psychotic disorders are particularly common clinical disorders in these patients, as are cluster B personality disorders [PDs; ( 18 – 20 )].…”